Wednesday, July 27, 2016

Dealing with and Treating Sleep Apnea

ResMed CPAP Machine with full-face mask
More than a month ago I was diagnosed with moderate to severe sleep apnea. When it exactly started, I am not entirely sure, but I must have had this sleeping disorder for at least two years now.

At first, I noticed that I would often wake up the next day feeling not refreshed and tired throughout the day. After nights of stronger sleep deprivation, I would end up forgetting simple things; once I could not remember the PIN number of my credit card (good thing that I had enough cash on me that day to finalize the purchase).

What would happen to me was that I would occasionally stop breathing, which is the Greek meaning of apnea, with pnea standing for breath. This would result in strange suffocating dreams. I would see myself in tight places that I needed to crawl and climb through. This was basically my brain signalling me to wake up as it was not receiving sufficient oxygen.

In other cases, I would wake up coughing and even gasping for air. This would be sometimes so strong that I would have to get up and walk to an open window to let the fresh air calm me. I attributed this to asthma, as I often find myself slightly short of breath even during the day, although thank goodness I don’t have asthma attacks and, in my case, it is on the milder side and does not leave me out of breath.

But my wise wife had told me to get checked for sleep apnea. I discarded this – out of pride or foolishness, or both – until the month of June where I had my worst sleeping episodes in my life. I would hardly get a wink, and if I did, I would wake up coughing. Once I just could not get to sleep, no matter how hard I tried - or did not try – and, all in all, I had perhaps one hour of sleep!

The next day was very difficult, not to say torture, but I am quite good at controlling my mood for the duration of my long workday. However, I would get home, completely exhausted and at times I felt even slightly depressed, which is generally quite an anomaly for me.

This continued for a while, with me forcing my way through days that should have been easy and enjoyable ... until one day I could not remember Tom Hanks! I could not remember the actor of Forrest Gump! I knew then that I had to go to our family doctor for a check-up.

As she heard about my symptoms and after asking some more questions, she concluded that I had sleep apnea and sent me to a clinic for a sleeping test. The test was at-home with an oximeter attached to a finger to check the oxygen rate of my brain as well as another device on my chest to check my pulse and heartbeat, I suppose. It was a doubly uncomfortable night, but at least it took place in the comfort of the home instead of an overnight stay at the hospital.

The next day, I found out that I had had about 250+ episodes of apnea over that night, which broke down to slightly less than 30 an hour! This was definitely not good news, but it was at least something to work with.

The sleep specialist checked with me one by one all the symptoms of classic sleep apnea: Yes, my weight gain over the years did not help the issue, my BMI was too high, my neck circumference was not good either; I did snore; I had trouble breathing through my nose; I woke up to go to the bathroom more than a few times at night; I had night sweats and occasional migraines the next day; I felt like shit.

Now before the diagnosis I had experimented with a new cervical pillow, breathing strips, a mouth guard, and they may have given me some slight relief, but nothing major nor of substance. So the chosen treatment, not cure, ended up the dreaded and feared CPAP therapy.

The CPAP machine, short for Continuous Positive Airway Pressure, is supposed to provide me with constant air pressure throughout the night. It detects episodes and provides the additional air to prevent them from becoming more serious.

The lack of oxygen, at some point in the quite dangerous territory of 70%, would cause damage not only to the brain but also to vital body organs and could lead to a number of ailments, including stroke, diabetes, and obesity. So in a way, it was a vicious cycle since part of my weight problems came from the disease itself, which ended up aggravating it!

As I cannot breathe through my nose, I was given a full-face mask. Now this looks worse than it is, but it is rather hard to get used to it. At first, the mask would feel too tight and not let me sleep. Then, once I somewhat got used to it, I had to worry about mask leaks. This means that the mask would not seal completely and air would escape making the treatment somewhat ineffective.

Then, after a while, I seemed to get the hang of it, but for some reason, my sleep specialist decided to increase the air pressure by 3 cmH2O. This was the worst part of the therapy as I would feel dizzy the next day, felt occasionally nauseous and slightly confused and would have headaches upon waking. I contacted him via email, but he did not respond until we met again on our then weekly appointments.

Now one thing needs to be mentioned here. You need a prescription to obtain a CPAP machine and it is purportedly illegal to change the pressure settings. Now as I am wont to do I had asked for side effects, and my specialist told me that it would be bloating, sometimes rashes as well as mask discomfort. Nothing serious though.

I looked up information online and almost all of them claimed that it was safe. The creator of the machine supposedly had said that the only way it could cause serious harm was to hit somebody over the head with the machine itself. CPAP has been deemed the best therapy under current standards.

However, the fact that it had to be prescribed first and then supervised did ring an alarm bell with me, alongside the numbness in my fingers upon waking at night. I would not be able to feel my pinkies, in some cases half of my hand and that was a side effect I did not like and that worried me a little.

It seems that it was more tolerable after the air pressure was regulated and decreased. My numbness was partly due to the positioning at night (I am usually a stomach sleeper, but with the mask and the tube, that becomes impossible). Although I did respect the opinion of my specialist, the fact that he is young and that he is selling the equipment for profit, I was suspicious of the whole thing. I had renamed it CRAP.

Yet, as they say, it takes time for one to adjust to this type of therapy. One really needs to be patient. After the specialist lowered the air pressure and found a suitable range (they have the ramp option, which increases air pressure slowly within certain given parameters), I ended up having a few relatively good nights of sleep. That means, for our intents of purposes here, I would sleep for the occasional three-hour block and briefly enter the deep sleep stage. That definitely made me feel better the next day.

I would still have the occasional dream of constricted space – for instance, last night I had a dream of two friends pulling my head underwater at an open-air swimming pool – but I would suddenly feel literally a fresh breath of air and would not awaken as a result.

I was given another test this time under the CPAP machine to check for any possible underlying issues, but the good news was that my oxygen levels were stable, and my incidents were low. On some nights I even reached the 0 threshold of incidents (my AHI was 0.0), which my sleep doctor had previously thought not to be really possible.

So there you have it! After some very difficult times and some additional difficult times to try to adjust to this machine, I have recently found better sleep! I am grateful for today’s technology and resources and in this particular case, there is an option (not app yet) to follow some general results of each night’s sleep. At ResMed, they even give you a (rather generous) user score to help you along.

I hope that my positive sleeping trend will continue, but in the meantime I know that I have to develop more healthy habits. Yet with better sleep, I should hopefully have a somewhat easier time of shedding some extra weight without having to overly sacrifice good food or the occasional wine in the process.

Anyhow, I hope this is of help for some readers out there. Nowadays I feel stronger affinity for others who also suffer from sleep apnea and are undergoing CPAP therapy. I have been following the message boards for tips and advice and thought I would share some of it with you right here on my blog.

If you are suffering from it or know someone who is, please consider my sympathy and a cyber high-five. If you suspect somebody from having this condition, please encourage them to see a sleep clinic as it is essential to discard this uncomfortable and possibly fatal disease.

If you do not have any sleep issues and have read this post merely out of curiosity or because of the simple and wonderful habit of reading my blog ; ) I would like you to cherish the fact that you have good sleep as there are many in the world who do not or cannot do so at night, whether they are suffering from sleep apnea, insomnia or any other sleeping disorders out there. And most importantly, I would like to wish all of you sweet dreams!

Monday, July 18, 2016

Race issues and Police Killings in the United States

Black nurse standing up to police officers in gear and armor
The recent cases of police officers being ambushed and killed in the United States is very frightening and alarming, to say the least. The fact that officers who are there to serve and protect us and whose job it is to uphold the law are slaughtered in a brutal and cowardly manner is a dangerous portent of anarchy and is a reprehensible act. There is, as President Obama has put it, no justification in those acts.

Yet although I fully condemn such atrocious acts, I can see how and why they have come about. Within the American police force, there are officers some of whom have abused their power and authority and have killed innocent black people. Unprovoked or exaggerated reactions towards people of color is nothing new, but nowadays thanks to current technology, it has come to the forefront; these incidents are unacceptable and completely out of place in any time period, but more so in our day and age. 

Surely, I am not one to believe that acts of violence can ever have positive effects, but I understand the sense of frustration and impotence when facing these abuses of power. These officers are like school bullies, except that the school authorities seem to side with them in this case. As a result, the victims feel helpless and let down by the system as a whole. In a society where self-defense is accepted and in some cases encouraged, acts of retribution may fall within dangerous perimeters of possible tolerance.

Innocent people have been killed on both sides of the spectrum and for those who believe two wrongs make a right, there may be a sense of vindication here. In fact, the shock and uproar over dead police officers is much more palpable and disproportionate compared to the continuous slayings of black people (there have been a number of documented cases in which the so-called perpetrators have been unarmed and even innocent).

This is where the hypocrisy of the system can be felt and where it does seem that the state favors its own, the police force over the general black populace. This is why movements like Black Lives Matter need to occur since in everyday life, their voices are not given the weight and importance they should.

If the state is interested in upholding a sense of justice and not merely protecting its flock or (inadvertently) sanctioning wrongdoings against the black population, something must be done in this regard. Put differently, if those who are supposed to protect the people (and that means all people not a select few of them), are not doing their job, then they ought to be punished under the full force of the law. If it ignores or justifies illegal proceedings and killings against a group of its citizens, then the state, as a whole, cannot be trusted or respected.

To reiterate my point, all of this is careless and dangerous. It can lead to utter chaos and unnecessary racial conflicts. This is all happening under the eyes of the first black president, and it is undermining progress that has been made over the past decades. 

This is not to say that the civil rights movement has reached or fulfilled its goals; many of those promises have fallen short and true equality is far from ideal, but both groups, white and black need to step up and find a way to deescalate the tensions and to ensure that things do not get worse before they get any better. 

There are three broad suggestions I would like to make for the state and the police force. I believe that first and foremost, we need to cleanse the force from its rotten apples. This needs to be done in a clear and impartial manner. 

Those who have committed crimes need to be brought to justice; some have, but many others have not. Merely wearing a uniform does not give people the right to break the law. The police union needs to stop supporting them, or else the shame and blame could fall upon each and very member of the law enforcement.

This means that all those good cops, and they are the silent majority here, ought to distance themselves from their evil brothers and even condemn and denounce any possible wrongdoings. I understand the feelings of solidarity and brotherhood among members of law enforcement, but in this situation they would be fully misplaced. Worse, this type of support for evildoers would endanger fellow police officers who are indeed doing a great job to secure peace and order in these chaotic and troubling times.

The second point is about the screening process itself. Police officers should not only be physically but also psychologically fit for the job. Any person who demonstrates bigotry or racist ideology should be immediately discarded from the position. They cannot be entrusted with protecting all citizens if they have their own inherent prejudices especially if those would interfere with their actions and could lead to cases of injustice.

Thirdly, the state must ensure that the police officers earn the salary they deserve and, more importantly, that they are not overworked. Police officers deal with human lives on a daily basis and they need to have sufficient rest as their job is stressful enough as it is. They fall in the same category as surgeons and pilots; if they are overworked, their lack of concentration and errors can cost human lives.

Also, they should have constant support and access to health services. Counselors have to be at hand for any traumas or stressful situations. Let’s face it, police officers have to deal with the worst types of people often on a daily basis. As a result, they can turn bitter, cynical, and even paranoid.

Police officers witness horrible and devastating scenes of pain and violence, and it is important that they can deal with all of these issues and that these experiences do not have a negative impact on their psychological and emotional well-being. A police officer needs to be constantly responsive. That includes being well-tuned to the respective situation and even have (if not show) empathy and compassion whenever necessary. A police officer who lacks those qualities cannot be fully effective and may make matters worse.

A final observation is also aimed at veterans. They are the ones who at the bidding of the state get their hands and fingers stained with blood; they kill in the name of their country and they risk being maimed and psychologically damaged as well as killed in the line of duty. The Dallas shooter had served in Afghanistan, while the Baton Rouge shooter had served as a marine in Iraq and their military service must have had traumatic impacts on their psyche. Veterans need to be treated well; they must be taken care of and the state owes them at least as much for all that they have done for the sake of the nation.

To sum up, the United States has reached an important breaking point, all of which is taking place in an election year. With all of this trauma, there is the chance to heal and forge ahead in unity against the ugly faces of hatred, bigotry, and racism. Killings need to come to an end, be it police officers or black people; at the same time, respect needs to ensue, a respect that involves both sides and that can hopefully lead to trust and peace among the diverse faces of the American nation.

Thursday, May 26, 2016

The Wonderful World of Pretense and Artifice: A Book Review of The Path

Book cover of the Path

In the modern Western world that stresses the importance of being yourself and of keeping it real at all possible times, anything that strays from the mantra of authenticity, such as pretense and artifice is frowned upon and discouraged. So the title of my review may sound rather critical and you may be awaiting a scathing and blistering attack on the book in question - The Path: What Chinese Philosophers Can Teach Us About the Good Life by Michael Puett and Christine Gross-Loh – but, in fact, it is quite the opposite.

Before I talk about the art of artifice, let us first take a closer look at a few concepts that we all claim to know and take for granted, such as being yourself. I have always wondered about this piece of advice given to people who feel distressed or confused in their lives and they are told just be themselves as if it would solve the issues at hand.

This panacean reply is just as confusing as anything else one could say to a suffering person. How can I be anyone but myself since I cannot be you? And more importantly, how do I know who I really am when I find myself acting and reacting differently in different kinds of social situations?  And which one of my potential selves is the right one and how can I be certain that this is indeed the right and most genuine version of myself?

The Path claims that most of what we see as ourselves is essentially and merely a series of patterned habits. I see myself responding in a certain way to a given situation over time and I assume that this is the most authentic response. It seems that being myself would be to act as naturally as I can; in other words, to act out what seems to me the most honest response at that moment.

But is that really the best method? If I feel angry, should I vent it and perhaps throw a book (maybe even this one) in the direction of the person causing my fit of anger?  Should I be blatantly and unabashedly honest with my friends and with my colleagues and superiors at work and give them all a piece of my authentic mind? Would that be the golden rule to follow?

The answer according to main Chinese philosophers, including Confucius and Laozi would be a simple no. Your fluctuating emotions and your patterned but limited perception of yourself is neither good for you nor for your surrounding and may not after all, be who you truly are. Yet one thing is for sure, that living on a steady whim and acting out your moment-to-moment desires cannot be constituting who you are. Or else we ought to be judging a toddler child not by their merits but by their tantrums.

So the first solution here before being yourself is to “get a grip on yourself.” We need to be aware of our seething and random emotions (qing) and also learn to control them (yi). Now this does not need to be undertaken in a dictatorial way in which we kill off any potential vitality with the cold iron-blade of reason and logic. This simply means to be the proverbial captain of the ship and not be thrown hither and thither by the winds of emotion but to steer them in the desired and most beneficial direction.

While doing so, a little bit of artifice (wei) may not be detrimental. Since you are refining yourself and your responses and interactions with the world, it would not be the worst to tame those wild feelings and passions of yours. Say, you literally feel passionate about an unknown person you have just had the pleasure to meet, and if you jump on them and cover them with wild kisses, most likely you will be seen as demented and may even be taken away in a straight-jacket to be forcefully re(de)fined.

In that situation, artifice would definitely come in handy. You can learn about how to flirt, read and memorize inside out the helpful and useful lines of Ovid’s Art of Love and use them to your own benefit. By restraining your passion for the moment, once the right occasion appears you can then unleash that part of your self for the benefit of you AND your chosen partner.

Both Laozi and Confucius would agree with those situations. The first one says that we need to be in the zone when it comes to acting out and hence living out the DAO, that is, we need to train the mind to become spontaneous. Now this may seem an oxymoron, but a spontaneous response ought not to be random but should be the one coming from the heart-mind (xin).

In fact, in this way you can calmly and carefully select the most appropriate and most genuine response among all the ones that pop up in your mind instead of wholeheartedly giving in to the first erratic impulses that arise. Of course, this involves a certain amount of training and discipline and cannot happen overnight. By learning to calm the waves, you gain the power to be as authentic as you wish.

The book gives the example of cultivating a hobby or sport. At first, you may be overwhelmed with all the new concepts or movements, but once you get the hang of it, you will be better at the given activity. That is when you can hone and refine your skills and will experience that wonderful moment of being in the zone, in which you instinctively know and respond to the situation. That is the natural state or the Way (Dao) and it takes practice and artifice to get to it.

The other undoubted benefit of being in the zone is related to the enjoyment of the given activity and by expansion the joy for life in general. The Path makes an interesting observation of how we use an activity, be it yoga or soccer to escape the mundane and the dreary aspects of day to day life. But that is only temporary bliss, as we will find ourselves again in the midst of stress and boredom. The trick is to manage to be in the zone or have “flow” constantly, just as the samurai has awareness of his surroundings at all times.

The benefit of such focus would be to feel vitality and not be dragged down by depressing or destructive and harmful thoughts about ourselves or life in general. We would enjoy whatever activity we undertake and not see a significant difference between doing the dishes and playing soccer. The activity will then turn (ideally speaking of course) from a chore to one of joy and, in the meantime, time will pass quickly.

Those kinds of activities may become rare with adulthood, but we see them often in children. They are at times so absorbed in what they are doing that they cannot hear us or seem to exist on a different plane of existence altogether. This is the purest form of DAO one can imagine and it is indeed something that comes naturally to us at first especially during childhood, but we seem to lose contact and connection with it over the years.

The second philosopher I want to discuss here is Confucius. The authors start off with the warning that we often misunderstand and misrepresent this great philosopher in our Western mind. We often rely on stereotypical thinking that is mainly transmitted to us from the idealistic and romantic 19th century. Confucius is often represented as striving for social harmony at the expense of individuality, that one ought to sacrifice one’s own ambitions and reign one’s desires for the common good. Now this is partially true, but there are deeper aspects and facets of his philosophy that many do not know about.

Enter the art of pretense. Even as an infant, we enjoy games of pretense. That is the basic premise of the joy behind peekaboo. The infant is presented with the possibility of disappearance of the adult only to face the immediate appearance. There may be an element of surprise here, but the infant does not take the whole situation at face value. I believe that the infant already knows this to be a game and hence does not feel threat or anxiety at the so-called albeit momentary disappearance of the parent. The movie The Witch demonstrates how such an innocent game could go horribly wrong, but that is another matter indeed.

The same can be applied to the popular game of hide-and-seek. This is where we simulate our disappearance, but do not stretch this far enough to become troubling. If we cannot find the child (again see The Witch) or if the child has trouble locating us, this game could easily turn into one of anguish and suffering. Hence, as a parent, more often than not, we let the child win and give away clues of our whereabouts, a foot sticking out or an intentional cough.

This game occurs on the level of pretense. We pretend to be lost and are then subsequently found. Both we and the child know this not to be a fact and it helps us to not only connect with each other in terms of an age-appropriate active game, but it also puts us on the same level or social standing. The parent temporarily suspends his role of the educator / enforcer and becomes a rather foolish counterpart to the child who assumes to be more competent and adept at this game. The child may or may not know that the reason they win this game is because the parent lets them. Yet either way, we are then reacting to our children less as a parental figure but more as a playmate.

The book refers to such moments as as-if worlds. It is commonly used in therapy sessions to shed light onto relationship issues. The roles are then reversed. The child is said to play the role of the parent and tell her what he thinks of her, while the parent does the same with the child. In such a way, we may unearth some conflicts and resentments and perhaps even misunderstandings between the two parties. Yet its strongest effect is the fact that we momentarily take on another person’s point of view and understand not only them but perhaps also ourselves a little better in the process.

This practice of pretending to be the other person can be expanded and applied to many different areas of one’s life. We can better understand the grumpy co-worker or the angry boss if we imagine and visualize the underlying dynamics of the situation. In fact, visualization, another type of pretense, helps us to improve our own skills. When we imagine ourselves in an activity or a situation, the brain goes through the motions, so-to-speak, and we can perform better in the real-life scenario, be it a presentation, a job interview or an athletic event.

In fact, athletes from soccer to hockey players tend to do such visualizations in the comfort of their home and often find themselves more successful on game day. I even give this type of advice to my own students: If you happen not to be a good student, then pretend to be one. What happens is that through rituals, you will gradually become more adept and competent in that endeavor and often, before you know it, you can master it! 

Rituals are highly encouraged in Confucianism, but in modern life, they are often frowned upon and dismissed as empty or pointless. The reason is that we see most of them as either a form of brainwashing or as a void gesture as they may not correspond with reality, beliefs that can themselves be traced to our Calvinist and Protestant legacies. But in itself, it is not a bad idea to follow certain rituals and practices whether one truly believes in them or not, simply because of all the beneficial effects it has on a personal as well as social level.

One example would be Christmas. Many people do not see it as the celebration of the birth of Christ, but rather as a time for festivities. We pretend that Santa exists, not because we enjoy lying to our children, but because it fosters feelings of excitement and joy within them and as a result, within us as well. We also see those times as a perfect opportunity for forgiveness and for healing. So we might pretend for the moment that bygones are indeed bygones.

It often works, temporarily. But what if we imagined, and I know this sounds corny and ask for your forgiveness, that every day was indeed Christmas. We might reduce our own conflicts and create more harmony among friends and relatives. We will more easily forgive the grumpy cashier or bus-driver. Or if we can’t actually forgive them, we pretend to do so.

What happens is that the pretense becomes real, especially with continued practice. A shy person may pretend to be confident and gradually, he may believe it to be true. Since he is pretending to be confident, he will be able to elicit the responses he is looking for and as a result, people around him may warm up to him. By immersing himself in this practice, he will, lo and behold, become confident, and that shy person may have been who he used to be in the past but does not refer to who he is at this particular moment.

And that leads us to the final point I want to embark upon, namely the belief that the world is stable. The Path claims this is not so, and that the perceived stability is merely an illusion. But this illusion can cost us and lead to faulty thinking and behavior, or at least, it may limit our options and possibilities.

Let us look at an example. A couple decides that they will get married on a certain day in the future. Now let us hope that this will be so, for their sake. But this assumption is based on a stable and predictable world. I am not saying that it won’t happen, but there are also many influences that could hinder the wedding from occurring ranging from the benign to the grave.

It could happen that somehow, for one reason or another, that particular circled day on the calendar may not be possible nor the best option. The assigned marriage commissioner might call in sick last minute leaving little option to get somebody else to replace her. Close relatives may face complications in their travel arrangements and may not make it on that day. Or simply, it may rain, or worse, there may be a hurricane passing through forcing you to postpone the wedding.

All of these impediments come from the outside. They might also occur from the inside. You may have major fights and decide to cancel the wedding. You or your partner may get cold feet or may meet somebody else in the meantime. Even worse, one of you may have an accident and die (sorry for the bleak image).

My point is that no matter how well-intentioned and structured our plan may be, it can always backfire. And the reason for this lies in the fact that life is indeed not always predictable. Our problem is that we think it is and feel frustration when it ruins our plans.

This may not always be for the worst. It might be that not getting married with that person would be a better option for you. Again, somebody else might come along who is more suitable and more compatible with you. By not limiting your options and not stubbornly and blindly adhering to the Plan but rather by going with the flow, we might save ourselves headaches and even find a better path to tread on.

In our life, we may feel stuck with one option. We may cling to a particular job because we feel that is the right one for us or that it is the best for our needs. Yet life - or fate / destiny (ming) - may present us with another opportunity that is better suited for our talents. If we do not give the other opportunities a thought and rigidly stick to what we have, we may be missing out. Likewise, what might be initially seen as a personal disaster (job loss or divorce) could lead towards brighter horizons in the future.

So I heartily recommend this book. Part of the reason is because I have previously thought about and struggled with those issues myself and that our conclusions are rather similar. Again, I do not fully agree with all the premises and tenets of The Path. I had my reservations at the start, but as I read along, I begin to appreciate it much more and consider it a healthy mix between philosophy and self-help.

I do not, however, agree with the view that the world lacks stability or structure, that it is random and chaotic. I think that there is a hidden moral center at work that does punish the evil and reward the good, and that this is not limited to the life we have now, but can be applied to future states of being. 

The authors seem to contend that the world and our life are unstable, but that we need to cultivate ourselves to respond to this fluctuating world. It seems that any kind of morality would boil down to pretense, imagination or social convention and it is not necessarily seen as a universal law or rather law of the universe. Put differently, the divine comes up a little short, although the utilitarian Mohists with the moral deity Heaven (Tian) align a little closer with my view.

Yet, for all intents and purposes, I think this book offers a refreshing look, explanation and most importantly, application of Chinese philosophy to our lives and it may offer relevant and necessary change in our way of thinking and especially living the good life. It also puts some of our given ideas and thoughts about ourselves and the world on its head, and I can only applaud the authors for such an outstanding hand-standing feat.